Abstract
Aim
Late acute prosthetic joint infections (PJI) treated with surgical debridement and implant retention (DAIR) have a high failure rate. The aim of our study was to evaluate treatment outcome in late acute PJIs treated with DAIR versus implant removal.
Method
In a large multicenter study, late acute PJIs were retrospectively evaluated. Failure was defined as: PJI related death or the need for prosthesis removal or suppressive antibiotic therapy because of persistent or recurrent signs of infection. Late acute PJI was defined as < 3 weeks of symptoms more than 3 months after the index surgery.
Results
A total of 445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n=20), 74.3% two-stage revision (n=78) and 6.7% definitive implant removal (n=7). Overall treatment failure was 45.0% (153/340) in the implant retention group versus 24.8% (26/105) in the implant removal group (p < 0.001). This significant difference remained after 1:1 propensity-score matching for confounding preoperative variables. No difference in failure was observed between one- and two-stage revision (25.0% (5/20) versus 24.4% (19/78), respectively (p 0.95)). DAIR was an independent predictor for failure in the multivariate analysis (OR 2.7, p 0.006). A high preoperative risk score for DAIR failure defined by a CRIME80 score ≥3 which included the exchange of the mobile components during DAIR as a protective factor, demonstrated a failure rate of 68.7% (57/83) in the DAIR group and a 16.7% failure rate (4/24) in the implant removal group (p < 0.0001). No significant difference in failure was observed with a CRIME80 score <3 (35.7% versus 23.9%, respectively (p 0.07).
Conclusions
Implant removal is associated with significantly better outcomes compared to debridement and implant retention in late acute PJIs with a high CRIME80 score and this should be taken into consideration when choosing the surgical strategy.
